Healthcare Claims Analytics Consultant

Job Family:

Travel Required:

Clearance Required:

What You Will Do:

We are seekingConsultantswith foundational experience inhealthcare claims data including exposure to validating loading processing and analyzing claims across various payer types (). This role supports the development and execution ofclaims analyses and auditsaimed at reducing improper payments identifying potential fraud and uncovering patterns that inform payment policy and cost-saving strategies.

• Demonstrate working knowledge ofclaims datasetsandhealthcare reimbursementconcepts.

• Assist in gathering and interpretingbusiness and technical requirementsfor claims audits and post-payment analysis.

• Conductdata-driven and qualitative researchto support payment policy evaluation and anomaly detection.

• Builddashboards and reportsusing coding tools to visualize claims trends and audit findings.

• Research and summarizeindustry-standard coding rulesand contribute to reimbursement policy discussions.

• Document findings and support the development ofrecommendations and follow-up actions.

• Contribute to analytics that identifypayment trendserrors andimproper payment risks.

• Stay informed onstate healthcare reform effortsand emerging policy changes.

• Translate research and claims review insights intobusiness requirementsfor analytics tools.

• Respond to inquiries and disputes related toclaims editsandpolicy interpretation.

• Collaborate with internal teams and external stakeholders to support project delivery.

• Support project management activities and contribute to client interactions.

What You Will Need:

• Bachelors degree from an accredited university.

• At least2 years of professional experience including1 year working with datasetsto derive insights and solve problems and 1 year of experiencecollaborating with internal or external stakeholders.

• Technical coding proficiency (e.g. SQL Python R) and experience developing basic dashboards and data visualizations.

• Exposure tohealthcare data analyticsandclaims data.

• Strong attention to detail and ability to prepare high-quality deliverables.

• Interest instate health agenciesMedicare/MedicaidVA and healthcare reform.

• Ability to obtain a Public Trust Clearance (US citizenship required)

What Would Be Nice To Have:

• 3 years of experiencein claims processing medical coding auditing or healthcare operations.

• Familiarity withreimbursement methodologiesprovider contracts and claims resolution practices.

• Experience withPower BI Tableau or similar tools for advanced data visualization.

• Strong written and oral communication skills.

• Ability to manage tasks independently and contribute to project execution.

What We Offer:

Guidehouse offers a comprehensive total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical Rx Dental & Vision Insurance

• Personal and Family Sick Time & Company Paid Holidays

• Position may be eligible for a discretionary variable incentive bonus

• Parental Leave and Adoption Assistance

• 401(k) Retirement Plan

• Basic Life & Supplemental Life

• Health Savings Account Dental/Vision & Dependent Care Flexible Spending Accounts

• Short-Term & Long-Term Disability

• Student Loan PayDown

• Tuition Reimbursement Personal Development & Learning Opportunities

• Skills Development & Certifications

• Employee Referral Program

• Corporate Sponsored Events & Community Outreach

• Emergency Back-Up Childcare Program

• Mobility Stipend

About Guidehouse

Guidehouse is an Equal Opportunity EmployerProtected Veterans Individuals with Disabilities or any other basis protected by law ordinance or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities or to apply for a position and you require an accommodation please contact Guidehouse Recruiting at 1- or via email at . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @ or . Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.

If any person or organization demands money related to a job opportunity with Guidehouse please report the matter to Guidehouses Ethics Hotline. If you want to check the validity of correspondence you have received please contact . Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicants dealings with unauthorized third parties.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.